fig4

Figure 4. 68-year-old with alcoholic induced cirrhosis presents with biopsy proven HCC in segment 6 (A). 1 month post-MWA there are expected posttreatment imaging findings of central T1 precontrast hyperintense signal related to coagulation necrosis (B), no APHE (C), no washout (D), LR-TR nonviable (white arrows). 6 months post-MWA there is a new 8 mm nodular masslike area of APHE (E), with no corresponding finding on delayed phase (F) (white arrowheads). By strict application of the LI-RADS TRA v2018, this is considered LR-TR viable, however, the reader chose to categorize this observation as LR-TR equivocal. Note the presence of mild diffusion restriction (G). 9 months post-MWA the previously seen area of APHE measures 1.1 cm (H), with washout and capsule appearance (I), now definitively LR-TR viable (black arrowheads). Of note, the use of diffusion restriction as an ancillary feature at 6 months could have upgraded this to definitive LR-TR viable category at 6 months.